Saturday, June 30, 2018

Diary of a Fourth-Year Vet Student: Student Doctor, Student Surgeon

I'm on my first rotation of my fourth year of vet school, also called the clinical year. This particular rotation is unique to Oregon State University because of the many years-long relationship they have with Oregon Humane Society in Portland. Every vet med student spends three weeks at OHS sometime during their clinical year.

In some ways, this is a good rotation to begin with. We are treated like, and are expected to act like, doctors. We are expected to make diagnoses, suggest appropriate rule-out and monitoring tests, and suggest appropriate medications. We are also responsible for patient care for hospitalized patients--cats and dogs who are too sick to be housed with the other animals and too sick to be adopted. They might need surgery. They might need drugs to treat infections. They might just need some TLC and encouragement to eat. We see our patients three, four, five times a day for several days in a row. Sometimes they get better. Sometimes they don't, which is hard on everyone. Last week, I had a parvovirus-infected dog who had been placed in isolation. For every visit, I had to put on booties over my shoes, a disposable (one-time use) plastic gown, and gloves. One night, I woke up around 1:30am worried about my patient. I quietly left my room and went down to isolation and put on all that PPE. I opened the door to find my classmate Claudia already there before me. She woke up a few minutes before I did, also worried about my patient (she also had a patient in isolation who had pneumonia). Turns out that my pup was indeed having a bit of a crisis (spiking a fever associated with secondary pneumonia) and we spent about an hour sorting out some changes in her treatment. We were tired and not thinking clearly and not working all that quickly, but we made some choices that turned out to be good ones. In this rotation, I'm learning a lot about medicine and how to be a vet.

Because this is an enormous shelter that has a goal of finding a home for every adoptable dog and cat, we also get to do lots of spays and neuters during our rotation here. During the fall term of our third year, we each did one cat spay, one dog neuter, and one dog spay. I also did a bonus 1/2 cat neuter (I did one testicle, a classmate did the other). That is typical for most vet programs. But with the OHS rotation, we are getting considerably more experience than that. After the end of my second week, I've done 8 or 9 dog neuters, 6 or 7 kitten spays, one adult cat spay, one dog spay, and 10 or 11 cat neuters (the actual tally is on a sheet back at OHS). In fact, just yesterday afternoon, I did a puppy neuter, two kitten spays, and an adult dog neuter--and I completed all of these surgeries in less than 2 hours. I was also working 90% solo (I had a bit of a struggle with one of the kitten spays and needed help resolving that--one of her uterine horns had wrapped around her bladder and I didn't recognize that was the problem--easy to fix, just exteriorize the bladder, unwrap the uterine horn, poke the bladder back in, and continue on). To give you an idea how amazing it is for me to do those surgeries in 2 hours, our student surgeries last year on just a single animal were usually three or more hours long (partly because of our inexperience but also partly because of the incredibly fussy and complicated protocols we had to follow). Yesterday, it was just me (no assistant), the animal on the table, a vet tech floating around monitoring anesthesia (we had three student surgeons working at the same time), and a clinician gowned and gloved ready to help if we had questions, but perfectly content to stand back and let us do it on our own. An experienced vet can do a dog neuter in 10 minutes, and a kitten spay in 15 minutes. We student vets aren't quite there yet!

Surgery is a terrifying thing. You make an incision, look inside and see guts moving around, and it really hits home that there is a living, breathing animal underneath that surgical drape. It is also a very complicated thing, even for simple procedures like dog neuters. You've got a lot of tools that need to be held and manipulated in a certain way. You've got suture--how to hold the needle, which pattern to use for which tissue. You've got tissue that can bleed--subcutaneous tissue in particular can bleed a lot and it can make your surgical field look messy and scary but you have to totally ignore it and move on. You've got lots of tissue that you don't want to touch--but it's always right there in your way. You've got a time pressure on you to get that animal off the table as quickly as you can. You've got other surgeries going on around you and it cannot become a race. You don't win by finishing first, you win by doing it right.

Kitten spays are quite something. It's like doing dollhouse surgery. You almost need magnification. The incision is typically the width of your index finger--or less if you are really good. Their tissues are tiny and delicate. And as I learned earlier this week, it is very easy to tear that tissue by accident if you don't handle it gently. My rookie mistake could have killed the kitten if it wasn't corrected right away. I was terrified and totally freaked out (screaming inside, more or less hanging together on the outside), but the clinician very calmly walked me through how to fix the problem. She then told me, we've all made this mistake, and it's good that you did it here where you can learn how to fix it and learn how to prevent it. Even so, I had to go outside and have a cry when I finished up with that kitten. Later that evening, I confessed my fears and anxiety to Claudia, and she and I went down to the cattery to check on the kitten. Kitten was eating, purring, looked just fine. Yesterday, I had to take some super deep breaths when the techs laid another kitten on the surgery table in front of me. Was I ready for that? We are all gowned and gloved and masked so you get really good at reading eyes and other body language signals. My classmates, working on their own dogs and cats, looked up and sang out, you've got this kitten! You can totally do this! So I did. Then I did a second kitten. And while I was a bit tentative with my tissue handling, that probably reduced resulted in a better job overall.

So we are looking after each other, learning to make decisions for our patients, learning how to handle tissue and do surgeries efficiently and safely, learning how to diagnose problems, learning, learning, learning.

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